Hearing
Assessment
Patients who have known significant risk factors for hearing loss need to be referred for formal audiometric assessment14 at baseline and on a regular basis after therapy.
Monitoring:
Audiological evaluation should be performed on all patients prior to receiving ototoxic therapy as a baseline and then also prior to each platinum-based course for patients at high risk for ototoxity3
Otolaryngology consultation referrals should be provided for patients who have:
- Chronic otitis media or externa
- Tympanic membrane abnormalities
- Any other anatomical problem that contributes to hearing loss21
General guidelines for baseline audiogram and long term follow up3:
High risk Patients:
- Platinum chemotherapy exposure (cumulative cisplatin ≥360 mg/m2 or carboplatin doses of ≥ 1000 mg/m2)
- RT dose of more than 30 Gy (to the ear, infratemporal, or nasopharyngeal area, the brain or craniospinal axis)
- Patients who received significant exposure to non platinum ototoxic agents (such as aminoglycoside antibiotics and loop diuretics)
Recommended to have audiologic monitoring on an annual basis for five years following the completion of therapy and if stable, every five years after that3
Patients who were younger than 10 years old at the time of therapy should continue annual monitoring until they are at least five years off therapy and at least 10 years old3
The frequency of testing should increase if there are any signs of progressive hearing loss to allow for compensatory measures to be put in place, such as hearing aids and other interventions3
Patients who are at lower ototoxicity risk, audiologic evaluation is recommended prior to every other platinum-based chemotherapy course3
